GW1-2023-02976_Well Construction - GW1_20230425

i
WELUCONSTRUCTION RECORD For Imcmalt}s ONLY:
TWO fortn can he used fdi.singlc,gr tmrlti}tk%Tells
t r
1.Wcll.Cnntrador infortuation:
'MAVATERZONES
John Eisenman MOM 7U I 0"NCRIPTION
\�'e1[CoritntclarNtinre. ft. R,
4439
NCIVcll Commciort'cnirimtionNimhcr :15 OUTER'CASING(rai' ulikiikil vicRs1''OR LINER'(iia i licabk,
FROM TO MAN LIR THICKNESS I MATEMAL
SAEDACCO Inc 0 IL. 17 r4 21i ia. SCH-40 PVC
Con�r:uy NaniC" .16jNNLR.CASING OR TLIBING:i mk iiciinat cWseil laii =
_IRON] 'TO 1 DIM1IMR TinCEME:SS NUTERL�L
2.'`V4 Conitr'uetioit OcIT"it 4" R, ft.'
LirifilJnpia7irnb}cuclPinrineis.(i_r Cnunry::Surc,.li�riurxr,lr�eabaticrr..J ft.: ft, in
3.Wc11 Iisc(chccl:1re11 rise): _MACRE:l N
Water Supply Well;- FROM. TO DI M.TPR i St.OTs17% THICKIMNS I 51ATnRVAt,
rl ecltltura.l CjNhinicip4 tblic 17 tt. 27 71. 2" is 010 SCHr40 PVC
©Geotltemial(EicatinefCooliog Supply) ©Residential Water Supply(single) tt• ft;'
©htdustriali'Conlntercial ®Residential AVater.Supp$'(slured) I GROUT: ..:
FROINL TO. MATERIAL EXPLAC'MENT AWMOD S AMOUNT
Oltri ulian' 0 ft.- 10 t4 Portland Pour
Nou-Wafter Stepll ty WOR:
�htpnitgrinG pRccmcty ft.. fl.
InjeclIon Well: ft, rt:
Clrliluifcr"Rcchargc CHADUgdll:INiRciilcdiatian 49F:SANDIGILILYEL`PAct{(ir `i'dicaLte►'` _'
' "6'RQ\1 TO dLi'CP,RrAI, ,Rfi1P1,ACt�IF:VTML'TflOn "
l7Atjnifcr:Storr q and>zccoFs►y Milinity BampP 14 R.: 27 ft, Sand #2 "
❑rlg1ferTest C15toininitcrUra,iri(toc
O.Expr drncnlal Teclmalac p$uhsidcrkc:Cdndtal.
2(I:ORR l ING I OG'(altach addllional slicefs if ncccsmfvl
a Ceutltenuat(ClosedLoop) OTrrcer F7tOi1 TO Aal
OCreothennal(Heatin Cooliue Retutn) DOther(e3pWit under,4421"Retnaths) 0 IL 32 " ft. Silt/sand/clay
4 Da&Wel((s)Coe;n e�e&4-13-23 WellIpyPIW-SSR ,
rl: fL
Sa:Well"L6clttorn tt. f4
Chemours tt. ft "
Facililq,ClnncrNalao Facility lll7(iCZppJicable). R ft; Qrl iaft3>rb���Pi
22828 NC-87, Fayetteville, NC, 28306
l!lnsklil i3ildrs s Citg:and Zip '21,RENIAR"
Cumberland Bentonite seal from 10-14'
C<mwy P-mvel Ikkillirtcollon No.(01N) "
5h.I:ntitudc and.C�n itil�lc in 1lcgtrcS/minutesJsce0"1 n1,dccitntd dcgtxcs 22:Ccrtitic tti,tu•
(ir ii all INW,One t 1!1usig 1K'Sad11Ci,)irt)
4/14/2023
Diie
G.Is(art)thr:u'ell(r)i MPerneattent ai ❑Temporvry g �t r= f i.;x•t.trcti oa
BY.risavig aleis fosii;., .a.,ifu.n,..;;. ..a.!!�.v i.:e:.i txmsrrirclert Lr;rrcY•arrfrmcr
rrfth 151MCACO2e =-r.•:;;i:e. ;2C.0200 Well Ceislr t-Hon SmMards widAurr41
7.L1 tUs a reparir to an ckwin,^„{fell: OV.t i fir -ENO .I d'{YapOf(lllr r/Y OiYI hnS l C6r1 1.1(led fool+(iH Jf fnf111'K
{f th(s:13"0 qY NT)r,fill rn+r ARO M ri140M3.rircrlrra 11(jgrrTW6.n miff c tptahi rlie nnnre of rite
reJlrrar remlrrd2l:remarkti st�rrmi Qr tvi JOE Mize..of diix fornc. 2.1 Site¢I)ry;rum or additional welt details:
Yon niay use&6ck of this pale"ta:provide'addiUonal well site:details:or*dl
8.Numberof wells eotuiructed: 1 r oustiuctfmriletails:You inay al -auactt udditioitat pages if fiLdessa►y.
For nralaiptc.Ulfet r1 nn irk aai-fairer supigy irefls ONLY tOth rhe.same cointri0ion,,y o-u Okra
ribmirn,ic form. SUBKTUTAL INSTUCTIONS
9•74tal ivOt depth Gre[air land srirfaci: 27 (ft.). .24A. For AU Will Subtait this fann within 30 days of c6wptcti6u'of%cell
For ivahipfe icellf Usk arrdeprhs fjdif,'enr r;(cxtm�pfe-.t er'y0(J'aruf'E Ilk7't consMiction to Qic following;
lU:StAtiewater level below lap of easing- (ly,) Ui�'Esiun of Miter Riwaurees,Informutiph Fiuccssiti�Uitit,
� Ivly r lad idroee c'us(ran,we"+" f v rmta.Senicc Center,Maleigh,NC'27691-I617
II:Borehole diameter,6" (ia) 24h:F:nr Infeetian Wetly ONLY: In addition to"sending.the femr to the add=in
24a abo)'e.also submit a copy of this fanil sviihin iO day s-of completion of iMl
12,Well construction method: Sonic c'n»stmction to the fallaiiine '
(LC.31Ig.:G resat}',,cnbl�`.dircct p�sti,.ctc.} -
DIviSioit 6f Water Resources,Underground Injection Control Program;
FOR WATER SUPPLY WELLS ONLY:' I636 hlut!Sc»ice.Ccutcr,Rallef}tti;;vC"27599+163<
t3a,'Vidd'(goo) Meiht(d of test: 2de.Foe,Water Supplt .&Inicctiou WcIh.-
Also subtmt aloe'copy. of this farin Mthin_0 daysof coropletioil.af
1311.Disinfcctian ty pet Amount• well coitstniciian to the catmty'health dcpament of'tlrc,county 11.11cre
constalctcd,
Funn GtF-I Nunh Carolina EAparrenent.oEEnt'irownciu aard Narw'J Resources-Dlvi.Ion 4 Rraler RMotlY-_ Revised August 2013.